I have been positive for a year and a half.....I am not on any medications. six months ago I had a flu and my VL went up to 64000 and my Cd4 was 283...I still resisted the meds....this month my Cd 4 is 400 and my VL has drop to 32000...My doctor still insist that I start meds.... I don't want to ...I feel great....Am I being foolish?

Response from Dr. Luzuriaga

Many factors are considered in thinking about when to start medication, including clinical status (presence of symptoms), CD4 counts, viral load, and the readiness of the patient to begin therapy. All existing guidelines recommend therapy for patients who are symptomatic but there is some variability among expert opinion regarding what CD4 count and viral load levels should be used to recommend therapy. In the US guidelines (available on this web site), therapy is recommended for CD4 count under 350 and viral load over 100,000 (although many experts would recommend therapy for anyone with a viral load over 30,000-50,000). CD4 counts can drop and viral load can rise transiently during an acute illness. Repeat testing after the acute illness has resolved is important to be sure that viral load and CD4 levels return to baseline. You and your care provider might wish to re-check your viral load and CD4 count at least once more (about a month after the last sample) and then discuss your options.

Antiretroviral therapy can help to keep you well for many years by suppressing viral replication and miminizing damage to your immune system. There are several good antiretrovirals with good safety and toxicity profiles -- several combinations can be given just once a day. So, if your care provider recommends therapy after addditional testing, you will likely have several options.

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